Applying the VR-CoDES in the dental context involving patients with complex communication needs

Introduction: The Verona Coding Definitions of Emotional Sequences (VR‐CoDES) has been previously applied in the dental context.  However, we know little about how dental patients with intellectual and/or communication difficulties (ICD) express their emotional distress during their dental visits, and how dental professionals manage these emotional concerns.  This study aimed to explore (a) the applicability of the VR‐CoDES to a dental context involving patients with ICD; and
(b) whether there is a need for modification of both systems of the VR‐CoDES‐CC and the VR‐CoDES‐P for future application in a similar setting.

Methods: Fourteen dental consultations were video recorded and coded using the VR‐CoDES, assisted with the additional guidelines for the VR‐CoDES in a dental context.  Both inter‐ and intra‐coder reliabilities were checked on the seven clips where cues were observed. Frequencies of cues/concerns and responses were computed and compared between categories.

Results: Sixteen cues (eight non‐verbal, no concerns) were identified within seven of the 14 consultations.  Twenty responses were observed (12 reducing space) with four multiple responses from both dentist and nurse.  Satisfactory reliability checks were achieved: Cohen’s Kappa was 0.76 (95% CI: 0,57, 0.94) for inter‐coder and 0.88 (95% CI: 0.86, 0.95) for intra‐coder.

Discussion: When assisted with the additional guidelines, cues and responses were reliably identified using the VR‐CoDES with this special dental patient group. Additional guidance is needed to improve the coding accuracy on multiple dental professionals’ responses and its impact on patient care.  The findings have provided a useful initial step toward an ongoing exploration of how healthcare providers in general identify and mange emotional distress of patients with diverse backgrounds and conditions.